Child-Size Radiation Dose

There is no doubt that medical imaging procedures save lives. However, one size does not fit all. Because children are three to five times more sensitive to radiation than adults,1 and cumulative radiation exposure can have adverse effects, it is critical for doctors to lower radiation levels when imaging a child.
Thatâ??s why in 2007, the Society for Pediatric Radiology (SPR) initiated the Alliance for Radiation Safety in Pediatric Imaging. Not long after, the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), and the American Association of Physicists in Medicine (AAPM) joined the Alliance. The Image Gently campaign is the Allianceâ??s initiative to raise awareness for lowering radiation dose used in pediatric imaging. The Alliance is actively working with imaging manufacturers to standardize dose assessment and display for children.
Although disagreements about the accuracy of the risk models or the degree to which the risks of radiation are emphasized are ongoing within the medical community, the message of the Image Gently campaign is clear: Reduce or â??child-sizeâ? the amount of radiation used when obtaining a CT scan in children. To â??child-sizeâ? the amount of radiation used, Image Gently encourages doctors to ask their medical physicist to determine the baseline radiation dose for an adult for that siteâ??s equipment and compare that dose with the ACR Standards.2
While these guidelines are clear, it is not certain how widely doctors have implemented these radiation-reducing measures to date. To gage the impact Image Gently on medical imaging practices, Imaging Technology News (ITN) spoke with Marilyn Goske, M.D., chair of the Alliance, and Neil Johnson, M.D., president of the Society for Pediatric Imaging, both practice at Cincinnati Childrenâ??s Hospital.
ITN: How serious a risk does radiation imaging pose to children?
Dr. Goske: One of the first things we need to remember is when children have imaging it is being done for an indicated medical condition and for a benefit for that patient. That is really what the Image Gently campaign revolves around. Once a study if medically indicated it behooves all of us in pediatric imaging to promote radiation protection and try to lower the dose and still maintain the quality of the exam so that we get the diagnostic information that we need. We know from studies, particularly from the atomic bomb survivors in Japan, that if children receive radiation from a bomb blast such as that one, they are more sensitive to radiation. Now medical imaging is different as itâ??s a different form of energy and quite diffrent in how itâ??s given for the imaging test, but itâ??s the best we have. The data from that tells us that we need to be overly cautious and conservative, and that if we are going to use this technology, we want to use it in the safest way possible.
ITN: How exactly is the Alliance standardizing dose assessment and display for children?
Dr. Goske: We are working together under the direction of Keith Straus, who is the medical physicist at Boston Childrenâ??s Hospital, Mr. Tom Toth, who is the former chief physicist at GE Healthcare, and Stephen Vastaghat the Medical Imaging Technology Alliance (MITA).
The four major CT vendors have signed on to come up with more standardized dose displays so that when we complete a CT scan and we look at the images on task and that we have the information we need to interpret the information more accurately. Under the current system the CT dose that is displayed, which is the CT dye volume and the DLC are based on 32-centimeter adult-size phantoms. So if the patient is on the table and is exactly the same size as the phantom, the dose display is reasonably accurate. But in our patient population where you have an infant who weighs 5 lbs., for example, the younger they are, the smaller they are compared to the size of the phantom, and the more discrepant the dose display is. According Mr. Strauss in a paper that he published,3 the dose display can be off by a factor of three. So we are actually underestimating radiation dose for those small patients. We are working with numbers to get those displays more accurate so that radiologists, radiologic technologists and medical physicists have a better idea of what our smaller patients are really getting in terms of radiation dose during CT scans and other imaging procedures.
Dr. Johnson: Itâ??s a very simplistic but important idea that we give our patients the right dose. We use the analogy of flying. We all fly in a commercial aircrafts, so we take risks. But there is a huge benefit when we minimize the risk. What we are trying to do is minimize the dose of radiation to children. We are not trying to stop these scans when they are needed medically. We are trying to do them with the minimum dose possible.

Fujifilm details its latest innovations in women's health including its ASPIRE Cristalle mammography system with digital breast tomosynthesis software option and its Synapse 5 PACS and VNA, enabling secure, easy-to-manage storage and access to the complete patient imaging record throughout the healthcare enterprise.

This 5 megapixel, high-brightness color monitor has the high-definition display necessary for breast imaging. It combines ease-of-use, such as a narrow bezel design to help your eyes swiftly move from one monitor to another, with new functions to help you focus on your work and maintain high performance.

ITN Contributing Editor Greg Freiherr offers an overview of artificial intelligence advances at the Radiological Society of North America (RSNA) 2017 annual meeting. AI was by far the hottest topic in sessions and on the expo floor at RSNA 2017. Here are links to related deep learning, machine learning coverage:

ITN Associate Editor Jeff Zagoudis demonstrates several mobile apps designed to help pediatric patients learn what an MRI exam is like to help calm their fears and make it easier to conduct the exam. Read the article "Pediatric MRI Calming Techniques"

Fujifilm details its latest innovations in women's health including its ASPIRE Cristalle mammography system with digital breast tomosynthesis software option and its Synapse 5 PACS and VNA, enabling secure, easy-to-manage storage and access to the complete patient imaging record throughout the healthcare enterprise.

This 5 megapixel, high-brightness color monitor has the high-definition display necessary for breast imaging. It combines ease-of-use, such as a narrow bezel design to help your eyes swiftly move from one monitor to another, with new functions to help you focus on your work and maintain high performance.

ITN Contributing Editor Greg Freiherr offers an overview of artificial intelligence advances at the Radiological Society of North America (RSNA) 2017 annual meeting. AI was by far the hottest topic in sessions and on the expo floor at RSNA 2017. Here are links to related deep learning, machine learning coverage:

Built on an over 25-year pioneering legacy in the advanced visualization industry, Vital continues to expand on three product lines that make up its Vitrea Enterprise Imaging portfolio: Vitrea Vision, Vitrea Connection and Vitrea Intelligence. Vital’s comprehensive enterprise imaging portfolio enables facilities to build a consolidated and standardized enterprise imaging strategy to meet the demands of today’s healthcare environment without the typical barriers associated with consolidating and standardizing. To introduce you to the full line of solutions, we’ll follow a fictional patient through an episode of care to see how Vital Images’ technologies help caregivers to efficiently provide high-quality care.

ITN Contributing Editor Greg Freiherr offers an overview of artificial intelligence advances at the Radiological Society of North America (RSNA) 2017 annual meeting. AI was by far the hottest topic in sessions and on the expo floor at RSNA 2017. Here are links to related deep learning, machine learning coverage:

Contributing Editor Greg Freiherr offers an overview of computed tomography (CT) advances at the Radiological Society of North America (RSNA) 2015. The video includes Freiherr during his booth tours with some of the key vendors who were featuring new technology.

Fujifilm details its latest innovations in women's health including its ASPIRE Cristalle mammography system with digital breast tomosynthesis software option and its Synapse 5 PACS and VNA, enabling secure, easy-to-manage storage and access to the complete patient imaging record throughout the healthcare enterprise.

This 5 megapixel, high-brightness color monitor has the high-definition display necessary for breast imaging. It combines ease-of-use, such as a narrow bezel design to help your eyes swiftly move from one monitor to another, with new functions to help you focus on your work and maintain high performance.

ITN Contributing Editor Greg Freiherr offers an overview of artificial intelligence advances at the Radiological Society of North America (RSNA) 2017 annual meeting. AI was by far the hottest topic in sessions and on the expo floor at RSNA 2017. Here are links to related deep learning, machine learning coverage:

Built on an over 25-year pioneering legacy in the advanced visualization industry, Vital continues to expand on three product lines that make up its Vitrea Enterprise Imaging portfolio: Vitrea Vision, Vitrea Connection and Vitrea Intelligence. Vital’s comprehensive enterprise imaging portfolio enables facilities to build a consolidated and standardized enterprise imaging strategy to meet the demands of today’s healthcare environment without the typical barriers associated with consolidating and standardizing. To introduce you to the full line of solutions, we’ll follow a fictional patient through an episode of care to see how Vital Images’ technologies help caregivers to efficiently provide high-quality care.

Chris Toth, president, global commercial and field operations for Varian, takes a tour of Varian’s new product introductions and major initiatives highlighted at ASTRO 2017. These include:
• The Halcyon system, a new platform for cancer treatment that simplifies and enhances virtually every aspect of image-guided volumetric intensity modulated radiotherapy (IMRT). Halcyon is a powerfully intuitive platform designed to help improve and strengthen the fight against cancer and enable access to high quality care anywhere in the world.
• The 360 Oncology care management platform, designed to integrate and coordinate patient care across the entire treatment and post-treatment journey. 360 Oncology brings together in a single platform, radiation, medical and surgical oncology, social services, primary care physicians, as well as the patient, to facilitate true collaboration and coordination.
• The latest release of Varian’s Eclipse treatment planning software, incorporating both Multi-Criteria Optimization (MCO) and Graphics Processing Unit (GPU) Support. MCO enables planners to look at tradeoffs in a treatment plan when different clinical criteria are varied, greatly enhancing control over optimization. GPU support decreases the dose calculation and inverse planning optimization times, providing a significant leap forward in speed.
• HyperArc high definition radiotherapy, technology that unlocks the potential of non-coplanar treatment strategies to usher in a new era of precision in the delivery of stereotactic radiosurgery (SRS).

Benjamin Movsas, M.D., chair of the American Society for Radiation Oncology (ASTRO) Scientific Committee, explains how research presented at the 2017 Annual Meeting was chosen to reflect new trends in radiation therapy.

The new Visicoil MR is a helically-wound, flexible linear fiducial marker. The Visicoil MR hollow core design and multiple sizes mitigates the CT artifact often created by traditional gold seeds, offering you clearer visualization of the tissue to aid in faster and more accurate contouring. Visicoil MR's linear flexible design fixates and remains stable in soft tissue, giving you the confidence in accurate marker localization. Visicoil MR is available in some of the smallest needle sizes available for fiducial markers, including 21g and 22g needles. The benefits of smaller needles are improved patient safety and comfort during implantation. The smaller needles may also allow for faster CT sim after implant and ultimately treatment for your patients. The new Visicoil MR with enhanced MRI visibility allows you to see the marker more easily in MRI, both in T1 and T2. This makes for easier and faster MR/CT fusion.

Melissa Martin, MS, president of the American Association of Physicists in Medicine (AAPM), discusses her vision of the role of medical physics in healthcare and highlights the association's initiatives at the 2017 AAPM annual meeting in Denver.

Join Chris Toth, president, Oncology Systems Americas, for a look at Varian’s new product introductions and major initiatives highlighted at ASTRO this year:

The 360 Oncology care management platform, the first software system designed to integrate and coordinate integrates relevant health information so cancer patients and their care teams can collaborate on the best care. 360 Oncology brings together in a single platform, radiation, medical and surgical oncology, social services, primary care physicians, as well as the patient, to facilitate true collaborative and coordinated care.

HyperArc high definition radiotherapy, technology that unlocks the potential of using highly non-coplanar treatment strategies to usher in a new era of precision. HyperArc is designed to automate and simplify sophisticated treatments such as stereotactic radiosurgery (SRS), and make them available to more cancer patients around the world.

Varian’s cyber-security initiative, which is transforming the company’s software platforms to help maximize the security of patient information, maintain the integrity of treatment delivery, and enhance clinical uptime by helping defend against cyber-attacks.

Fujifilm details its latest innovations in women's health including its ASPIRE Cristalle mammography system with digital breast tomosynthesis software option and its Synapse 5 PACS and VNA, enabling secure, easy-to-manage storage and access to the complete patient imaging record throughout the healthcare enterprise.

ITN Associate Editor Jeff Zagoudis demonstrates several mobile apps designed to help pediatric patients learn what an MRI exam is like to help calm their fears and make it easier to conduct the exam. Read the article "Pediatric MRI Calming Techniques"

Mindray recently featured a new upgrade for its premium Resona 7 ultrasound system at the Radiological Society of North America annual conference. The new upgrade is based on the system’s core ZONE Sonography Technology (ZST+), which enables software upgrades for new applications such as contrast enhanced ultrasound (CEUS), Sound Touch shear wave elastography and 10 new transducer options. Other imaging, software, and calculation enhancements include fetal CNS “Smart Planes,” “Smart Pelvis” and a dedicated pelvic congestion syndrome package. The new transducers include C6-2GU interventional/intraoperative; C11-3U microconvex; P10-4U and P7-3U phased pediatric cardiac; P7-3TU adult transesophageal; L16-4HU; SC6-1U and DE10-3WU (3D). There are also two new CW transducers, CW2S and CW5S, for the support of shared service. The new upgrade is expected to be available to Resona 7 customers early next year. For more information: www.mindraynorthamerica.com

Prem Soman, M.D., director of nuclear cardiology at the Heart and Vascular Institute, University of Pittsburgh, and president-elect of the American Society of Nuclear Cardiology (ASNC), explained advances in PET and SPECT imaging and the learning curve involved in reading scans from the new CZT SPECT cameras. Watch the VIDEO: Trends in Nuclear Cardiology Imaging, an iknterview with David Wolinsky, M.D., director of nuclear cardiology at Cleveland Clinic Florida. Read the related article "Advances in Cardiac Nuclear Imaging."

Kim A. Williams, Sr., M.D., chief of cardiology at Rush University Medical Center, Chicago and former president of both the American College of Cardiology (ACC) and the American Society of Nuclear Cardiology (ASNC), explains the impact of healthcare reform on cardiology and specifically on nuclear perfusion imaging.

David Wolinsky, M.D., director of nuclear cardiology at Cleveland Clinic Florida and past-president of the American Society of Nuclear Cardiology (ASNC), discusses advancements in nuclear imaging and some of the issues facing the subspecialty.

American Association of Physicists in Medicine (AAPM) President John Boone, Ph.D., discusses the impact of imaging in medical physics, as well as key topics addressed at this year’s meeting, with Imaging Technology News Editorial Director Melinda Taschetta-Millane.

Introducing HYPERSCAN , Pencil Beam Scanning Delivery HYPERSCAN enables tumor volumes to be scanned in a matter of seconds, benefiting from the MEVION S250's direct and efficient beam generation. The result is a fast Pencil Beam Scanning enabling robust Intensity Modulated Proton Therapy treatment delivery that is much less sensitive to patient and tumor motions, ultimately increasing the efficacy of the treatment procedure. The MEVION S250 proton therapy platform with HYPERSCAN allows you to treat with precision, accuracy and reproducibility at unparalleled speed with uncompromised beam quality. Designed for greater access by any size cancer care facility, the MEVION S250 significantly reduces the complexity, size, and cost associated with conventional proton therapy systems. The MEVION S250 is specifically engineered as upgrade-ready to continue providing the most advanced proton therapy treatment available today as well as tomorrow. Key Features : Field-Upgradeable; Streamlined Clinical Workflow with Full OIS Integration; High-Accuracy Beam Pointing with Submillimeter Position Tracking; Fast Volumetric and Layer Rescanning Capabilities; Supports Standard Gating Interface for Beam On/Off Hold

DAIC Editor Dave Fornell shares his choices for the most innovative new technologies in nuclear imaging that were on display at the 2014 Society of Nuclear Medicine and Molecular Imaging (SNMMI) annual meeting.

This 5 megapixel, high-brightness color monitor has the high-definition display necessary for breast imaging. It combines ease-of-use, such as a narrow bezel design to help your eyes swiftly move from one monitor to another, with new functions to help you focus on your work and maintain high performance.

ITN Contributing Editor Greg Freiherr offers an overview of artificial intelligence advances at the Radiological Society of North America (RSNA) 2017 annual meeting. AI was by far the hottest topic in sessions and on the expo floor at RSNA 2017. Here are links to related deep learning, machine learning coverage:

ITN Associate Editor Jeff Zagoudis demonstrates several mobile apps designed to help pediatric patients learn what an MRI exam is like to help calm their fears and make it easier to conduct the exam. Read the article "Pediatric MRI Calming Techniques"

Built on an over 25-year pioneering legacy in the advanced visualization industry, Vital continues to expand on three product lines that make up its Vitrea Enterprise Imaging portfolio: Vitrea Vision, Vitrea Connection and Vitrea Intelligence. Vital’s comprehensive enterprise imaging portfolio enables facilities to build a consolidated and standardized enterprise imaging strategy to meet the demands of today’s healthcare environment without the typical barriers associated with consolidating and standardizing. To introduce you to the full line of solutions, we’ll follow a fictional patient through an episode of care to see how Vital Images’ technologies help caregivers to efficiently provide high-quality care.

Konica Minolta President of Healthcare IT Steve Deaton details new features in the Exa Platform designed to improve clinician efficiency from the beginning of patient care through completion. For more information, visit www.konicaminolta.com/medicalusa

Fujifilm details its latest innovations in women's health including its ASPIRE Cristalle mammography system with digital breast tomosynthesis software option and its Synapse 5 PACS and VNA, enabling secure, easy-to-manage storage and access to the complete patient imaging record throughout the healthcare enterprise.